Title Page
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Ladder Reference Number:
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Client / Site
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Conducted on
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Inspector
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Stepladder
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Size (FT.)
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Type
- Fiberglass
- Aluminum
- Wood
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Steps: Loose, Cracked, Bent, or Missing
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Rails: Cracked, Bent, Split, or Frayed Rail Shields
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Labels: Missing or Not Readable
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Pail Shelf: Loose, Bent, Missing, or Broken
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Top: Cracked, Loose, or Missing<br>
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Spreader: Loose, Bent, or Broken
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General: Rust, Corrosion, or Loose
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Other: Bracing, Shoes, Rivets
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ACTIONS:
- Ladder tagged as damaged & removed from use
- Ladder is in good condition
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Extension Ladder
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Size (FT.)
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Type
- Fiberglass
- Aluminum
- Wood
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Rungs: Loose, Cracked, Bent, or Missing
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Rails: Cracked, Bent, Split, or Frayed
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Labels: Missing or Not Readable
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Rung Locks: Loose, Bent, Missing, or Broken
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Hardware: Loose, Missing, or Broken
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Shoes: Worn, Broken, or Missing
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Rope/Pulley: Loose, Bent, or Broken
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Other: Bracing Rivets
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General: Rust, Corrosion, or Loose
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ACTIONS:
- Ladder tagged as damaged & removed from use
- Ladder is in good condition
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Specialty Ladder
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Model Number:
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Type
- Fiberglass
- Aluminum
- Wood
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Steps/ Rungs: Loose, Cracked, Bent, or Missing
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Rails: Cracked, Bent, Split, or Frayed
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Labels: Missing or Not Readable
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Hardware: Loose, Missing, or Broken
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Fasteners: Rust, Corrosion, Loose, or Missing
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Top: Cracked, Loose, or Missing<br>
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Spreader: Loose, Bent, or Broken
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Outriggers: Missing, Rust, Corrosion, or Loose for scaffolding
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General: Rust, Corrosion, or Loose
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Hinges: Loose, Bent, or Missing
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Locks: Loose, Bent, Broken, or Missing
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Bracing- Front/ Rear: Loose, Bent, Broken, or Missing
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Rail Shield: Missing or Loose
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Casters: Rust, Corrosion, or Loose for scaffolding
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ACTIONS:
- Ladder tagged as damaged & removed from use
- Ladder is in good condition
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Inspector Signature
